Original Research

Effects of Resistance Training Performed to Failure

or Not to Failure on Muscle Strength, Hypertrophy,
and Power Output: A Systematic Review
With Meta-Analysis
Alexandra F. Vieira,1 Daniel Umpierre,2,3,4 Juliana L. Teodoro,1 Salime C. Lisboa,1 Bruno M. Baroni,5
Mikel Izquierdo,6 and Eduardo L. Cadore1
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1
Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul;
2
Department of Public Health, University of Rio Grande do Sul, Porto Alegre, RS, Brazil; 3National Institute of Science and Technology
for Health Technology Assessment (IATS/HCPA), Clinical Research Center, Clinicas Hospital of Porto Alegre, RS, Brazil; 4Exercise
Pathophysiology Laboratory, Graduate Program in Cardiology and Cardiovascular Sciences, University of Rio Grande do Sul, Porto
Alegre, RS, Brazil; 5Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre,
RS, Brazil; and 6Navarrabiomed, Hospital Complex of Navarra (CHN)-Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain

Abstract
Vieira, AF, Umpierre, D, Teodoro, JL, Lisboa, SC, Baroni, BM, Izquierdo, M, and Cadore, EL. Effects of resistance training
performed to failure or not to failure on muscle strength, hypertrophy, and power output: A systematic review with meta-analysis. J
Strength Cond Res XX(X): 000–000, 2021—The aim of this review was to summarize the evidence from longitudinal studies
assessing the effects induced by resistance training (RT) performed to failure (RTF) vs. not to failure (RTNF) on muscle strength,
hypertrophy, and power output in adults. Three electronic databases were searched using terms related to RTF and RTNF. Studies
were eligible if they met the following criteria: randomized and nonrandomized studies comparing the effects of RTF vs. RTNF on
muscle hypertrophy, maximal strength, and muscle power in adults, and RT intervention $6 weeks. Results were presented as
standardized mean differences (SMDs) between treatments with 95% confidence intervals, and calculations were performed using
random effects models. Significance was accepted when p , 0.05. Thirteen studies were included in this review. No difference was
found between RTF and RTNF on maximal strength in overall analysis (SMD: 20.08; p 5 0.642), but greater strength increase was
observed in RTNF considering nonequalized volumes (SMD: 20.34; p 5 0.048). Resistance training performed to failure showed a
greater increase in muscle hypertrophy than RTNF (SMD: 0.75; p 5 0.005), whereas no difference was observed considering
equalized RT volumes. No difference was found between RTF and RTNF on muscle power considering overall analysis (SMD: 2
0.20; p 5 0.239), whereas greater improvement was observed in RTNF considering nonequalized RT volumes (SMD: 20.61; p 5
0.025). Resistance training not to failure may induce comparable or even greater improvements in maximal dynamic strength and
power output, whereas no difference between RTF vs. RTNF is observed on muscle hypertrophy, considering equalized RT
volumes.
Key Words: repetitions maximal, fatigue, strength training, muscle size, muscle power

Introduction adaptations to RT (59,60). This theory is based on the size

It has been widely shown that resistance training (RT) improves
maximal and explosive strength, and it is beneficial for sports
performance in athletes (25,26) and for functional capacity in
nonathletes (14). One of the most popular approaches to pre-
scribing RT is establishing the load correspondent to a range of
maximal repetitions (RMs) (3,28,29), in which transient con-
centric failure is achieved at the end of performed sets
(i.e., 4–6RMs or 10–12RMs). It has been argued that performing
RT sets to failure (RTF) would maximize motor unit (MU) re-
cruitment and would, consequently, optimize neuromuscular
Address correspondence to Dr. Eduardo L. Cadore, edcadore@yahoo.com.br.
Supplemental digital content is available for this article. Direct URL citations appear
in the printed text and are provided in the HTML and PDF versions of this article on
the journal’s Web site (http://journals.lww.com/nsca-jscr).
Journal of Strength and Conditioning Research 00(00)/1–11
ª 2021 National Strength and Conditioning Association
principle, suggesting that as consecutive repetitions are per-
formed, the lower-threshold MUs (i.e., those composed of type I
muscle fibers) are fatigued and, consequently, high-threshold MU
(i.e., those composed of type II muscle fibers) recruitment will be
maximized (6,59,60). However, there are some controversial
findings in studies investigating this issue using electromyography
signals (EMGs) because it has been demonstrated that a higher
EMG signal is achieved and stabilized before the repetition cor-
responding to muscular failure (10,55). In addition, over several
sets of an exercise, such accumulated fatigue can result in a re-
duction in total overload (i.e., volume and load), compared with
nonfailure sets (17,36). Based on the association between total
mechanical overload (i.e., sets 3 repetitions 3 load) and muscle
hypertrophy (27,51), a reduction in overload could impair the
hypertrophic responses.
In healthy people, RTF seems to result in marked neuromuscular
gains (1,24,28,44), although evidence that training leading to

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 Meta-analysis on RT to Failure or Not (2021) 00:00
concentric failure is superior to RT not leading to failure (RTNF).
Indeed, several studies have shown that RTF did not induce addi-
tional muscle strength gains compared with RTNF in young trained
and untrained populations (12,13,25,26,35,48), whereas a smaller
number of studies observed greater strength increase after RTF
(8,15,47). In addition, it seems that RTF does not induce further
muscle size enhancements in young (35,40,48) and older individuals
(53), although this outcome is less investigated. Regarding muscle
power output, it has been shown that RTF may compromise muscle
power improvements in highly trained athletes (25,26), whereas
another study has shown similar muscle power adaptations between
RTF and RTNF in older adults (2). Therefore, there are controversial
results regarding the influence of repetitions to failure in the RT
adaptations. In this regard, a meta-analysis study could be useful to
provide more solid evidence, due to the controversial findings.
In a previous meta-analysis by Davies et al. (6), who subsequently
published an article erratum (7), the authors demonstrated that there
are no differences in strength gains after RTF and RTNF. Not-
withstanding, this study only addressed maximal strength, and
analyses on muscle hypertrophy and muscle power output adapta-
tions were not performed. In addition, since the publication of this
work (6), several other articles on this topic have been published,
providing more data on the comparison between failure and not to
failure approaches during RT (2,12,35,40,53).
Although sets using repetitions to failure promote mechanical and
muscle function adaptations, it is also notable that a certain degree of
fatigue may induce high levels of discomfort and physical exertion,
preventing the correct execution of the movement, particularly in
nonexperienced practitioners (56,59). In this sense, it is believed that
the performance of RTF in the long term could increase the risk of
overuse injuries (6). Moreover, repetition to failure also implies a
longer time under tension, leading to greater increases in blood
pressure, heart rate, and rate-pressure product (16,34,39), which
may increase the risk of cardiovascular complications in some pop-
ulations. In addition, RTF induces a greater metabolic impact at the
cellular level (17,18), which may result in the need of a greater time of
recovery between exercise sessions.
Therefore, it seems relevant to determine whether there are addi-
tional benefits of performing RTF or if its adaptations are comparable
with those observed when submaximal repetitions are performed,
taking into account the influence of total volume on these adaptations
(i.e., compensating or not compensating the number of repetitions with
additional sets). Thus, the purpose of this study was to systematically
review randomized and nonrandomized longitudinal studies on the
effects of RT performed to concentric failure or not to failure on muscle
strength, hypertrophy, and maximal power output in healthy young
subjects and in older adults. In addition, we also assessed if there was an
influence of RT volume (equalized or not equalized) in this comparison.
Our hypothesis was that RTF would not provide additional benefits on
muscle strength and power output. Moreover, we also hypothesized
that no difference between RTF and RTNF would be observed on
muscle hypertrophy, considering equalized RT volumes.
Methods
Experimental Approach to the Problem
To test the authors’ hypothesis, we performed a systematic review
with a meta-analysis of longitudinal studies investigating the ef-
fects of RT performed to failure vs. not to failure on
muscle strength, hypertrophy, and power output. This review
was registered at http://www.crd.york.ac.uk/prospero as
CRD42020155608. The study has been reported according to
Copyright © 2021 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) (32,52). This study was approved by the
Institutional Review Board of Universidade Federal do Rio
Grande do Sul (Federal University of Rio Grande do Sul).
Subjects
Three hundred eighty-four subjects from 13 studies were included
in the analysis. Ninety-two studies included only men and only
women, respectively; and 2 studies included a mixed sample.
Three hundred thirty-two subjects were young adults (mean age
range: 21.6–26.7 years old), while 52 were older adults (mean age
range: 65.6–66.7 years old). In addition, four studies were per-
formed with athletes (30.8%), eight with untrained individuals
(61.5%) and one with recreationally resistance-trained individ-
uals (7.7%) (Table 1). All studies mentioned that written in-
formed consent documents were obtained for all subjects.
Procedures
Eligibility Criteria. In this review, we considered longitudinal
studies (randomized or nonrandomized) that compared the effects of
RTF vs. RTNF for a period $6 weeks on muscle hypertrophy,
muscle strength, and maximal power output in young and older
trained and untrained adults. Studies were included if they assessed
at least one of the following outcomes: (a) muscle hypertrophy using
ultrasound, magnetic resonance images, or computed tomography
measurements; (b) dynamic muscle strength through isoinertial tests
(i.e., 1RM, 3, or 6RMs) in at least one exercise; or (c) maximal power
output using vertical jumps, free weights, or plated load RT exer-
cises. In the case of studies with different publications related to the
same outcome (i.e., short-term and long-term adaptations), only one
study was included. In this case, we chose to include studies with
training periods similar to those of the other studies included in this
review.
Search Strategy. The search was performed in October 2019 using
the electronic databases MEDLINE (PubMed), Web of Knowl-
edge (Web of Science), and Cochrane. In addition, manual
searches from the references of the included studies were per-
formed. After starting the literature search, we excluded 2 data-
bases previously described during the registration. These
exclusions were due to the high cost associated with the search in
these databases. In addition, we performed a search for gray lit-
erature at http://www.opengrey.eu/. There was no limitation on
the language or year of the study.
The search comprised the following terms and MeSH terms
(and their respective related terms): “humans,” “adult,” “aged,”
“resistance training,” “maximal repetitions,” “muscular failure,”
“muscular exhaustion,” “muscle fatigue,” “failure,” “repetition
failure,” “repetition exhaustion,” and “repetition maximum.”
To optimize the capture of relevant references, such terms were
combined by boolean operators (OR and AND). The full search
strategy performed in the PubMed database is available as Sup-
plemental Digital Content 1 (see Supplementary Material, http://
links.lww.com/JSCR/A251).
Selection of Studies. The selection of studies was based on the
eligibility criteria previously adopted and performed in-
dependently and in duplicate. First, 2 pairs of researchers in-
dependently evaluated the titles and abstracts of all studies found
in the search (A.F.V. and E.L.C., and J.L.T. and S.C.L.; each pair
 Meta-analysis on RT to Failure or Not (2021) 00:00
evaluated half of the studies). Articles whose abstracts did not
provide sufficient information as per the inclusion and exclusion
criteria were assessed separately in full. Subsequently, each study
selected in the previous phase was fully evaluated and selected by
the reviewers independently. Disagreements were resolved by
consensus, and in cases of persistence, a third investigator re-
solved the disagreement between the other pair of researchers
(E.L.C. and J.L.T.). To avoid inclusion of duplicate studies (dif-
ferent publications using identical study groups), we screened the
period and place of recruitment, and the authors were contacted
for clarification when necessary.
Data Extraction. Standardized forms were adopted for data ex-
traction, and the data extraction was performed independently by
2 pairs of reviewers (A.F.V. and E.L.C., and J.L.T. and S.C.L.;
each pair extracted data from half of the studies). Eventual dis-
agreements were resolved by consensus or by a third investigator
from another pair (E.L.C. and J.L.T.). In this phase, the main
characteristics of the selected studies, such as sample size and
sample characterization, variables related to interventions, and
results of the outcomes of interest, were detailed. Missing data
were requested from the researcher of the study in question. In
case of no answer, denying provision, or data loss, the article or
outcome was excluded. For data presented only graphically, the
results were extracted using DigitizeIt software.
The extracted outcomes were the absolute deltas of the values
referring to muscle hypertrophy, maximal strength, and maximal
power output. When not available, the delta was calculated from
the values obtained before and after the intervention, and the
delta SD was imputed by the equation proposed by Higgins and
Green (20).
In studies comparing RTF with 2 or more RTNF groups using
different training approaches, we chose the most similar com-
parator group in terms of training variables (i.e., same number of
exercises and more similar contraction speed in the concentric
and eccentric phases). However, studies in which the RTF group
was compared with RTNF groups using equalized and non-
equalized volumes (2,35,53), both comparisons were included in
the analysis. In these cases, the sample of the RTF group was
divided in half in each comparison to avoid overestimating the
study weight and the sample size in the analyses (19).
Risk of Bias Assessment. The assessment of risk of bias in the
individual studies included adequate random sequence genera-
tion, allocation concealment, blinding of subjects and personnel,
blinding of outcome assessment, description of losses and exclu-
sions, and intention-to-treat analysis, as proposed by the
Cochrane Collaboration (20). When these characteristics were
described in the published document, it was considered that the
criteria were met and they were classified as “low risk” or “high
risk.” Studies that did not describe these data were classified as
“unclear risk.” This evaluation was performed independently by
2 pairs of reviewers (A.F.V. and E.L.C., and J.L.T. and S.C.L.).
Statistical Analyses
Statistical analyses was performed through a meta-analysis
comprising the comparison of RTF with RTNF on muscle hy-
pertrophy, maximal dynamic strength, and maximal power out-
put. Subgroup analyses included comparisons between RTF and
RTNF with and without equalized volumes, as well as overall
analysis (i.e., considering both cases within the same compari-
son). In addition, sensitivity analyses were performed for lower-
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| www.nsca.com
body and upper-body maximal dynamic strength, muscle power
output, and muscle hypertrophy. Moreover, sensitivity analyses
on maximal strength and maximal power were also performed for
sports athletes and nonathletes, as well as single-joint and mul-
tijoint exercises for the upper and lower body. Furthermore, in
each analysis, we removed studies individually, one after the
other. This strategy (known as “leave-one-out”) is recommended
for further exploring between-study heterogeneity (beyond the I-
squared calculation) because it allows for the identification of any
substantial change in the direction of results whenever a single
study is removed from the analysis. This exploratory procedure is
a recommended practice, particularly for meta-analyses with a
limited number of studies (58). In all comparisons, we considered
only analyses including at least 3 studies. Thus, to include at least
3 studies in each sensitivity or subgroup analysis, we pooled data
from exercises composed of similar muscle groups. For example,
for the analysis of lower-body muscles, we pooled data regarding
the leg press and squat exercises, whereas for upper-body anal-
ysis, we pooled data from bench row and biceps curl exercises.
The results are presented as standardized mean differences
(SMDs) between treatments with 95% confidence intervals (CIs).
The calculations were performed using random effects models.
The statistical heterogeneity of treatment effects between studies
was assessed using the I2 inconsistency test, considering that
values higher than 50% indicated high heterogeneity (21). Values
of a # 0.05 were considered statistically significant.
Publication bias was verified through visual observation of the
funnel graph of the analyzed variable. Asymmetry was tested
using the Begg and Egger test and was considered to be significant
when p , 0.10. In case of publication bias, the trim-and-fill test
was used to estimate the publication bias effects on interpreting
the results. All analyses were performed using Stata version 15.1.
Results
Study Selection
The search of MEDLINE (PubMed), Web of Knowledge (Web of
Science), and Cochrane databases provided a total of 4,150 ci-
tations. In addition, 3 studies were identified through manual
searches from the references of the included studies, and 271
studies were found through the search for gray literature. After
duplicates were removed, 4,096 studies remained. Of these, 4,080
studies were discarded after reviewing the titles and abstracts.
Thus, the full texts of the remaining 16 citations were examined in
more detail (none of the gray literature). After integral reading, 13
studies met the inclusion criteria and were included in the quan-
titative analysis (Figure 1).
Description of the Studies
The 13 studies included in this review contributed to the analysis
and comprised 384 subjects. Of these, 171 individuals partici-
pated in RTF interventions, whereas 213 participated in RTNF.
Regarding the sexes in study samples, 9 and 2 studies included
only men and only women, respectively, and 2 studies included a
mixed sample. Most subjects included were young adults
(86.5%), whereas only 52 (13.5%) were older adults. Further-
more, 4 studies were performed with sport athletes (30.8%), 8
with untrained individuals (61.5%), and 1 with recreationally
resistance-trained individuals (7.7%) (Table 1).
The interventions consisted of RT performed with 1–40 sets of
1–22 repetitions at intensities ranging between 65% 1RM and
 Meta-analysis on RT to Failure or Not (2021) 00:00
Figure 1. Flowchart of studies included. RM 5 repetition maximum.
92% 1RM. The weekly frequency of RT protocols ranged from 2
(46.2%) to 3 times (53.8%), and RT periods ranged from 6 to 14
weeks of follow-up. Of the 13 studies included, 5 studies used
comparator groups with a nonequalized RT volume, 5 with an
equalized RT volume, and 3 with both comparisons. In addition,
4 studies assessed muscle hypertrophy, 12 assessed maximal
strength, and 5 assessed maximal power output (Table 2).
Risk of Bias
Among the studies included, 15.4% (2/13) clearly reported ran-
dom sequence generation, 15.4% (2/13) reported allocation
concealment, none (0/13) implemented blinding or masking
procedures to subjects or personnel, 15.4% (2/13) blinded the
assessors to the outcomes, 38.5% (5/13) described sample losses
and exclusions, and none (0/13) performed intention-to-treat
analyses (see Table S1, Supplemental Digital Content 1, http://
links.lww.com/JSCR/A251).
Effects of Interventions
Maximal Dynamic Strength: Meta-Analysis and Subgroup
Analysis. Data on maximal strength were obtained from 12
studies (8,9,13,25,26,30,35,40,47–49,53) comprising a total of
384 individuals. In the overall analysis, no difference was found
between changes induced by RTF and RTNF (SMD: 20.08; 95%
Copyright © 2021 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
CI: 20.42, 0.26; p 5 0.642; I2: 67.3%) (Figure 2). We also did not
observe publication bias in this analysis (Egger’s regression, p 5
0.786) (see Figure S1, Supplemental Digital Content 1, http://
links.lww.com/JSCR/A251).
The results of the subgroup analysis based on RT volumes
(i.e., equalized or not equalized) showed an advantage in maximal
strength gains in favor of the nonfailure approach, considering
nonequalized RT volumes (SMD: 20.34; 95% CI: 20.67,
20.003; p 5 0.048; I2: 31.5%) (Figure 2). On the contrary, no
significant difference was found between RTF and RTNF when
considering equalized RT volumes (SMD: 0.16; 95% CI: 20.38,
0.69; p 5 0.566; I2: 75.3%) (Figure 2).
Each study included in this analysis was removed individually.
Therefore, when we removed 5 of the 12 studies included
(26,30,40,48,49), this difference in favor of RTNF when con-
sidering nonequalized volumes disappeared.
Sensitivity Analyses. Owing to the heterogeneity between the
studies, sensitivity analyses were performed in the interventions
for the following (see Figures S2–S7, Supplemental Digital Con-
tent 1, http://links.lww.com/JSCR/A251): lower-body exercises
in which a significant difference was observed in favor of RTNF
(SMD: 20.38; 95% CI: 20.69, 20.07; p 5 0.015; I2: 23.1%);
lower-body exercises (comparator, nonequalized volume) (SMD:
20.37; 95% CI: 20.91, 0.17; p 5 0.179; I2: 54.6%); lower-body
exercises (comparator, equalized volume) in which there was a
difference in favor of RTNF (SMD: 20.41; 95% CI: 20.82,
 Meta-analysis on RT to Failure or Not (2021) 00:00 | www.nsca.com

Table 1
Characteristics of subjects.*
Studies Groups Subjects (n) Sex (M/F) Age (y)† Body mass (kg)† BMI (kg·m22)† Training status
Cadore et al. (2),‡,§ Failure‡,§ 17 17/0 66.1 6 5.0 79.4 6 10.6 27.1 6 3.2 UT
Nonfailure‡ 20 20/0 66.7 6 6.1 80.3 6 10.6 27.7 6 2.8 UT
Nonfailure§ 15 15/0 65.6 6 3.4 87.9 6 0.1 30.9 6 4.8 UT
da Silva et al. (53),‡,§ Failure‡,§ 17 17/0 66.1 6 5.0 79.4 6 10.6 27.1 6 3.2 UT
Nonfailure‡ 20 20/0 66.7 6 6.1 80.3 6 10.6 27.7 6 2.8 UT
Nonfailure§ 15 15/0 65.6 6 3.4 87.9 6 0.1 30.9 6 4.8 UT
Drinkwater et al. (8) Failure 15 15/0 NR NR NR SA
Nonfailure 11 11/0 NR NR NR SA
Drinkwater et al. (9) Failure 7 7/0 NR NR NR SA
Nonfailure 7 7/0 NR NR NR SA
Folland et al. (13) Failure 12 8/4 22.0 6 2.0 70.0 6 3.0 NR UT
Nonfailure 11 7/4 20.0 6 1.0 68.0 6 7.0 NR UT
Izquierdo et al. (25) Failure 14 14/0 24.8 6 2.9 81.1 6 4.2 24.9 6 2.5 SA
Nonfailure 15 15/0 23.9 6 1.9 80.5 6 7.4 24.6 6 1.9 SA
Izquierdo-Gabarren et al. (26) Failure 14 14/0 25.4 6 4.2 79.8 6 5.3 NR SA
Nonfailure 15 15/0 26.7 6 5.7 83.2 6 6.3 NR SA
Kramer et al. (30) Failure 16 16/0 NR 78.4 6 8.4 NR T
Nonfailure 14 14/0 NR 76.8 6 10.1 NR T
Martorelli et al. (35),‡,§ Failure‡,§ 30 0/30 22.3 6 3.8 63.7 6 22.5 NR UT
Nonfailure‡ 27 0/27 21.6 6 3.3 62.5 6 14.1 NR UT
Nonfailure§ 32 0/32 21.7 6 2.8 60.2 6 13.5 NR UT
Nóbrega et al. (40) Failure 14 14/0 NR NR NR UT
Nonfailure 14 14/0 NR NR NR UT
Rooney et al. (47) Failure 13 NR NR NR NR UT
Nonfailure 14 NR NR NR NR UT
Sampson and Groeller, (48) Failure 10 10/0 23.4 6 6.6 76.9 6 0.2 NR UT
Nonfailure 10 10/0 23.7 6 6.2 85.0 6 13.7 NR UT
Sanborn et al. (49) Failure 9 0/9 NR 62.8 6 9.2 NR UT
Nonfailure 8 0/8 NR 70.9 6 12.1 NR UT
*M 5 males; F 5 females; BMI 5 body mass index; T 5 trained; UT 5 untrained; SA 5 sports athletes; NR 5 not reported.
†Mean 6 SD.

20.00; p 5 0.049; I2: 0.0%); multijoint lower-body exercises
(SMD: 20.43; 95% CI: 20.93, 0.07; p 5 0.089; I2: 45.3%);
single-joint lower-body exercises (SMD: 20.34; 95% CI: 20.74,
0.07; p 5 0.105; I2: 0.7%); upper-body exercises (SMD: 0.25;
95% CI: 20.30, 0.81; p 5 0.367; I2: 76.0%); upper-body exer-
cises (comparator, nonequalized volume) (SMD: 20.30; 95% CI:
20.72, 0.13; p 5 0.168; I2: 0.0%); upper-body exercises (com-
parator, equalized volume) (SMD: 0.57; 95% CI: 20.20, 1.33; p
5 0.146; I2: 79.1%); multijoint upper-body exercises (SMD:
0.34; 95% CI: 20.43, 1.10; p 5 0.387; I2: 64.1%); single-joint
upper-body exercises (SMD: 0.21; 95% CI: 20.61, 1.03; p 5
0.615; I2: 83.1%); sport athletes (SMD: 0.08; 95% CI: 20.50,
0.66; p 5 0.783; I2: 64.5%); and nonathletes (SMD: 20.16; 95%
CI: 20.58, 0.26; p 5 0.465; I2: 70.0%).
Muscle Hypertrophy: Meta-Analysis and Subgroup Analysis.
Data on muscle hypertrophy were obtained from 4 studies
(35,40,48,53) comprising a total of 189 individuals. Resistance
training performed to failure was associated with a greater in-
crease in muscle size compared with RTNF (SMD: 0.75; 95% CI:
0.22, 1.28; p 5 0.005; I2: 63.8%) (Figure 3). We did not observe
publication bias in this analysis (Egger’s regression, p 5 0.457)
(see Figure S8, Supplemental Digital Content 1, http://links.lww.
com/JSCR/A251).
The results of the subgroup analysis on the influence of RT vol-
ume (equalized or not equalized) showed an advantage in favor of
the failure approach when considering nonequalized RT volumes
(SMD: 0.82; 95% CI: 0.09, 1.56; p 5 0.028; I2: 70.7%) (Figure 3).
On the contrary, no significant difference was found between RTF
and RTNF when considering equalized RT volumes (SMD: 0.59;
95% CI: 20.39, 1.58; p 5 0.239; I2: 70.4%) (Figure 3).
Each study included in this analysis was removed individually.
Therefore, when we removed 3 of the 4 studies included
(35,48,53), there were changes in these results.
Sensitivity Analyses. Owing to the heterogeneity found between
the studies, sensitivity analyses were performed in the interven-
tions for the following (see Figures S9 and S10, Supplemental
Digital Content 1, http://links.lww.com/JSCR/A251): lower-
body muscles (SMD: 0.34; 95% CI: 20.31, 0.99; p 5 0.302; I2:
48.6%) and upper-body muscles (SMD: 1.15; 95% CI: 0.60,
1.70; p 5 0.000; I2: 38.3%). Because of the low number of studies
(i.e., ,3), we did not perform sensitivity analysis considering the
subgroups (i.e., equalized and nonequalized RT volumes).
Muscle Power Output: Meta-Analysis and Subgroup Analysis.
Data on maximal muscle power output were obtained from 5
studies (2,8,9,25,26) comprising a total of 150 individuals. No
significant effect was found between RTF and RTNF (SMD:
20.20; 95% CI: 20.53, 0.13; p 5 0.239; I2: 32.7%) (Figure 4).
There was no evidence of publication bias in this analysis (Egger’s
regression, p 5 0.945) (see Figure S11, Supplemental Digital
Content 1, http://links.lww.com/JSCR/A251).
The results of the subgroup analysis on the influence of RT
volume (equalized or not equalized) showed an advantage in fa-
vor of the RTNF approach when considering nonequalized RT
volumes (SMD: 20.61; 95% CI: 21.15, 20.08; p 5 0.025; I2:
27.5%) (Figure 4). On the contrary, no significant difference was

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 Meta-analysis on RT to Failure or Not (2021) 00:00

Table 2
Training characteristics of studies.*
Rest† Frequency (days Duration Hypertrophy Strength Power
Studies Groups Sets Repetitions Intensity (s) Volume‡ per week) (wk) test test output test
Cadore et al. (2),§,‖ Failure§,‖ 2 to ;7.7–;22.2 65–75% 120 Nonequalized 2 12 NE NE SJ and CMJ
3 1RM
Nonfailure§ 2 to 4–10 65–75% 120 Equalized
3 1RM
Nonfailure‖ 4 to 4–10 65–75% 120
6 1RM
da Silva et al. Failure§,‖ 2 to ;7.7–;22.2 65–75% 120 Nonequalized 2 12 Ultrasound QF 1RM LP NE
(53),§,‖ 3 1RM and KE
Nonfailure§ 2 to 4–10 65–75% 120 Equalized
3 1RM
Nonfailure‖ 4 to 4–10 65–75% 120
6 1RM
Drinkwater et al. (8) Failure 4 6 80–105% 230 Equalized 3 6 NE 6RM BP 40 kg BP
6RM
Nonfailure 8 3 80–105% 100
6RM
Drinkwater et al. (9) Failure 4 6 90–100% 165 Equalized 3 6 NE 3RM and 40 kg BP
6RM 6RM BP
Nonfailure 8 3 90–100% 73
6RM
Folland et al. (13) Failure 4 10 75% 1RM 30 Equalized 3 9 NE 1RM KE NE
Nonfailure 40 1 75% 1RM 30
Izquierdo et al. (25) Failure 3 5–10 80–100% 120 Equalized 2 11 NE 1RM BP 60% 1RM BP
6-10RM and SQ and SQ
Nonfailure 6 3–5 80–100% 120
6-10RM
Izquierdo-Gabarren Failure 3 to 4–10 75–92% NR Nonequalized 2 8 NE 1RM BR BR at different
et al. (26) 4 1RM loads
Nonfailure 3 to 2–5 75–92% NR
4 1RM
Kramer et al. (30) Failure 1 8–12 75–81% 120 to Nonequalized 3 14 NE 1RM SQ NE
1RM 180
Nonfailure 3 10 66–75% 120 to
1RM 180
Martorelli et al. Failure§,‖ 3 NR 70% 1RM 120 Nonequalized 2 10 Ultrasound EF 1RM BC NE
(35),§,‖ Nonfailure§ 3 7 70% 1RM 120 Equalized
Nonfailure‖ 4 7 70% 1RM 120
Nóbrega et al. (40) Failure 3 Not clear 80% 1RM 120 Nonequalized 2 12 Ultrasound VL 1RM KE NE
Nonfailure 3 Not clear 80% 1RM 120
Rooney et al. (47) Failure 1 6 6RM No rest Equalized 3 6 NE 1RM BC NE
Nonfailure 6 1 6RM 30
Sampson and Failure 4 ;6.1 85% 1RM 180 Nonequalized 3 12 Magnetic 1RM BC NE
Groeller (48) resonance EF
Nonfailure 4 ;4.2 85% 1RM 180
Sanborn et al. (49) Failure 1 8–12 8 to 12RM NR Nonequalized 3 8 NE 1RM SQ NE
Nonfailure 3 2–10 2 to 10RM NR
*RM 5 repetition maximum; QF 5 quadriceps femoris; EF 5 elbow flexors; VL 5 vastus lateralis; LP 5 leg press; KE 5 knee extension; BP 5 bench press; SQ 5 squat; BR 5 bench row; BC 5 biceps curl;
SJ 5 squat jump; CMJ 5 countermovement jump; NR 5 not reported; NE 5 not evaluated.
†Between sets.
‡Between intervention and comparator groups.

found between failure and nonfailure training when considering
equalized RT volumes (SMD: 0.03; 95% CI: 20.31, 0.36; p 5
0.881; I2: 0.0%) (Figure 4).
Each study included in this analysis was removed individually.
Therefore, when we removed 2 of the 5 studies included (8,26),
there were changes in these results.
Sensitivity Analyses. Owing to the heterogeneity found between
studies, sensitivity analyses were performed in the interventions
for the following (see Figures S12–S17, Supplemental Digital
Content 1, http://links.lww.com/JSCR/A251): lower-body
exercises (SMD: 20.23; 95% CI: 20.59, 0.13; p 5 0.211; I2:
0.0%); lower-body exercises (comparator, nonequalized volume)
(SMD: 20.36; 95% CI: 20.92, 0.20; p 5 0.207; I2: 0.0%); lower-
body exercises (comparator, equalized volume) (SMD: 20.14;
95% CI: 20.61, 0.33; p 5 0.563; I2: 0.0%); upper-body exercises
(SMD: 20.16; 95% CI: 20.92, 0.61; p 5 0.690; I2: 70.7%);
upper-body exercises (comparator, equalized volume) (SMD:
0.19; 95% CI: 20.35, 0.74; p 5 0.486; I2: 21.0%); jump power
output (SMD: 20.28; 95% CI: 20.69, 0.14; p 5 0.188; I2:
0.0%); bench press power output (SMD: 0.19; 95% CI: 20.35,
0.74; p 5 0.486; I2: 21.0%); sports athletes (SMD: 20.14; 95%

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 Meta-analysis on RT to Failure or Not (2021) 00:00 | www.nsca.com

Figure 2. Forest plot of the maximal strength promoted by resistance training (RT) performed to concentric failure vs.
RT performed not to failure. The estimation for each subgroup (1: nonequalized volume and 2: equalized volume) and
the combined effect (overall) are detailed. The squares and error bars signify the standardized mean differences
(SMDs) and 95% confidence interval (95% CI) values; the diamonds represent the pooled estimates of random
effects meta-analyses.

CI: 20.72, 0.44; p 5 0.636; I2: 61.0%); and nonathletes (SMD: 2
0.28; 95% CI: 20.69, 0.14; p 5 0.188; I2: 0.0%).
Discussion
This systematic review with meta-analyses summarized the evi-
dence induced by RTF or RTNF on maximal strength, muscle
hypertrophy, and maximal power output in adults. Overall anal-
yses indicated no differences between RTF and RTNF with regard
to training-induced gains in maximal strength and power output
outcomes. When considering studies that consisted of non-
equalized volume in RT, we observed an association between
RTNF with greater maximal strength and muscle power increase,
in comparison with RTF. Furthermore, we observed an association
between RTF with greater muscle hypertrophy when compared
with RTNF, considering nonequalized RT volumes; however, this
difference was not found in the analyses when taking into account
only studies that equalized the total training volume.
Some authors have argued that RTF could optimize neuro-
muscular improvement compared with RTNF based on size prin-
ciple of motor unit recruitment (11,54,59). Notwithstanding, only
few studies have confirmed the superiority of RTF in isoinertial
strength outcomes (8,47), whereas most studies have not found
differences between the RTF and RTNF approaches on strength
increase (9,13,25,35,53). In addition, a meta-analysis by Davies
et al. (6), who subsequently published erratum (7), did not confirm
differences between RTF and RTNF on strength enhancement.
Our meta-analysis agrees with most of the aforementioned
studies because no differences were observed in the strength in-
crease on overall analysis. However, when we examined the
subgroup analyses splitting studies that either equalized or did not
equalize the total volume, an advantage in favor of RTNF when
considering nonequalized RT volumes was observed. One pos-
sible explanation could be that RTF induced greater load decrease
across the sets due to transient muscle fatigue (17,18), and a RT
load is determinant of strength improvements (27,51). Among the
studies that did not equalize RT volumes, some of them used the
same number of sets and lower numbers of repetitions in the
nonfailure RT (i.e., a lower RT volume in the nonfailure groups)
(26,35,40,53), whereas 2 of them used 3 sets not to failure com-
pared with one set to failure (i.e., a greater RT volume in the
nonfailure groups) (30,49). Therefore, although RT intensity
seems to be a stronger determinant of strength increase than RT
volume (27,51), the influence of RT volume on this outcome
cannot be ruled out. In fact, some previous studies have found
greater strength improvement after RT regimes composed of
more sets (31,38), although this is controversial (45).
A sensitivity analysis provided insights into this comparison
(i.e., RTF vs. RTNF): when considering only lower-body exer-
cises, there was a statistically significant greater strength in-
crease in favor of the nonfailure approach in equalized RT
volume studies (see Figures S7 and S8, Supplemental Digital
Content 1, http://links.lww.com/JSCR/A251). By contrast, no
differences were observed between the failure and nonfailure
approaches in upper-body strength. Although some physiolog-
ical responses in different muscle groups could affect adaptation
induced by the failure or nonfailure strategies, our synthesis was
limited and could not explore such factors in depth. Based on
our findings, it seems that there is an influence of the muscle
group assessed, and our data suggest that RTNF may be more
beneficial to lower-body muscles, whereas no differences were

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 Meta-analysis on RT to Failure or Not (2021) 00:00

Figure 3. Forest plot of the muscle hypertrophy promoted by resistance training (RT) performed to concentric
failure vs. RT performed not to failure. The estimation for each subgroup (1: nonequalized volume and 2:
equalized volume) and the combined effect (overall) are detailed. The squares and error bars signify the
standardized mean differences (SMDs) and 95% confidence interval (95% CI) values; the diamonds represent
the pooled estimates of random effects meta-analyses.

observed for upper-body muscles. It should be mentioned,
however, that sensitivity analyses on lower- and upper-body
muscles combined different exercises (i.e., squat and leg press or
bench row and biceps curl) to achieve at least 3 studies per
analysis. Therefore, caution is needed when considering these
results because, in some cases, different exercises may provide
different stimuli.
Few studies have compared the effects of RTF with RTNF on
muscle hypertrophy (40,48), particularly after controlling for
equalization of the RT volume (35,53). Our synthesis has shown

Figure 4. Forest plot of the maximal power output promoted by resistance training (RT) performed to concentric
failure vs. RT performed not to failure. The estimation for each subgroup (1: nonequalized volume and 2:
equalized volume) and the combined effect (overall) are detailed. The squares and error bars signify the
standardized mean differences (SMDs) and 95% confidence interval (95% CI) values; the diamonds represent
the pooled estimates of random effects meta-analyses.

Copyright © 2021 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
 Meta-analysis on RT to Failure or Not (2021) 00:00
greater muscle size increase after repetitions to failure both in the
nonequalized RT volume studies (i.e., a greater RT volume in the
RTF groups), as well as in the overall analysis (considering
equalized and nonequalized RT volumes). Nevertheless, consid-
ering only equalized volume comparisons, no differences were
observed between RTF and RTNF interventions. Likewise,
Martorelli et al. (35) and Da Silva et al. (53) observed greater
muscle thickness increases in RTF compared with RTNF per-
formed with 50% of the possible maximal repetitions, but these
differences did not occur when equalizing RT volumes between
groups. Indeed, the literature has shown that muscle hypertrophy
is highly associated with the total RT volume, which determines
the total mechanical overload applied on muscles (27,51).
Therefore, it seems that the advantage of performing repetitions
to failure in the muscle hypertrophy is due to a greater training
volume rather than a fatigue stimulus. In this way, it does not
seem possible to compare the effects of the RTF and RTNF ap-
proaches on muscle hypertrophy with no volume equalization.
Our sensitivity analysis indicated that RTF and RTNF induced
comparable increases in the lower-body muscles size, whereas
RTF has shown superiority in upper-body muscle size gains. Be-
cause of the small number of comparisons, we did not perform a
sensitivity analysis for lower-body and upper-body muscle split-
ting for equalized and nonequalized RT volumes in muscle hy-
pertrophy. Thus, based on the influence of the total RT volume in
muscle size gains, it is important to carefully consider the in-
fluence of repetitions to failure or not to failure in different muscle
groups because of the small number of studies assessed in this
article.
Muscle power output is associated with high performance in
athletes (22,23,33) and with functional capacity in nonathletes
across their life span (4,5,46). The present meta-analytic results
do not show differences in muscle power increase after RTF and
RTNF, either with equalized volume or in the overall analysis
(considering equalized and nonequalized RT volumes). However,
when considering the comparisons for RTF vs. RTNF with no
volume compensation (i.e., a lower RT volume in the RTNF
groups), there was a difference in favor of RTNF. These results
may be explained by the current evidence that shows marked
decreases in maximal muscle action velocity and, consequently,
muscle power after RTF sets (17,50). These characteristics
(i.e., velocity and power) are determinants of muscle power in-
creases after RT intervention (42). Moreover, it has been shown
that RT composed of shorter sets, higher mean velocity, and less
fatigue induces greater improvements in muscle power out-
put (43).
However, there is one aspect that may limit the failure vs.
nonfailure comparison in the muscle power outcome in the pre-
sent meta-analysis, i.e., not all interventions were designed as
power-type RT and used at the intended maximal velocity across
the sets. Therefore, it is possible that even greater differences in
favor of RTNF would be observed if the included studies had used
maximal velocity in their training groups, as observed in the study
by Izquierdo-Gabárren et al. (26) investigating elite rowers. Dif-
ferent to maximal strength, sensitivity analyses did not show
distinct patterns of differences between RTF and RTNF in upper-
body and lower-body limbs regarding muscle power gains, in-
cluding in the analysis of only jump power output.
When considering separately the studies that assessed athletes
and nonathletes, no differences between RTF and RTNF on
maximal strength and power output gains were observed. Among
the 4 trials investigating sports athletes, 2 did not show differences
between RTF and RTNF in power output increase (9,25), and one
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| www.nsca.com
showed greater gains after RTNF (26). These findings might be
relevant to highly trained athletes, considering the efficiency of the
nonfailure approach, because RTF induces a greater metabolic
impact at the cellular level (17,18), which may result in longer
recovery periods between exercise sessions. In addition, it has been
suggested that the use of repetitions to failure for long-term training
could increase the risk of overuse injuries and overtraining poten-
tial (6), although no direct evidence has been provided. Because
athletes need to combine the RT with their specific sports training,
it seems rational to use a low volume of repetitions during RT
(i.e., training not to failure), considering that this approach will
promote similar or even greater muscle strength and power im-
provement than training to failure. Analyses of maximal strength
and power output when considering nonequalized RT volumes, as
well as sensitivity analysis of lower-body strength, indicated that
RTNF could be particularly beneficial for athletes who experience
high demands of specific training and competition (41).
If we consider improvement in neuromuscular function and
promotion of health, the same premise is useful for nonathletes
because our findings suggest that RTNF can optimize strength
enhancements and, at the same time, reduce high levels of dis-
comfort and physical exertion, preventing the incorrect execution
of the movement (59). Moreover, RTF also implies a longer time
under tension, leading to greater increases in blood pressure,
heart rate, and rate-pressure product (16,34,39), which may in-
crease the risk of complications in populations at higher cardio-
vascular risk.
There are a number of limitations that should be acknowledged.
The risk of biases of the included studies was high or unclear for
assessed aspects in most of the studies. In addition, we observed a
high heterogeneity in the maximal strength and muscle hypertro-
phy outcomes, and this heterogeneity remained moderate after
sensitivity analyses for muscle hypertrophy and was low to high for
maximal strength analyses. Moreover, although the RTF approach
can be similar among studies, the same is not observed among
RTNF approaches, thereby leading to possible influence in com-
parability between trials. For example, in the study by Nóbrega
et al. (40), the RTNF group performed a volitional number of
repetitions (before failure), whereas in other studies, the number of
repetitions was controlled and ranged from 50 to 70% of the
maximal repetitions possible (2,25,26,35,53), and these differences
can confound the results. Likewise, to control the influence of RT
volume on neuromuscular adaptations, some trials created a
nonfailure group after equalizing the RT volume doubling the sets.
Although it addresses an interesting aspect (i.e., RT volume in-
fluence), it may also generate others biases. One of them is creating
RT groups with an unrealistic number of sets and training session
durations. Another problem is adding a third training group in the
comparison, thereby possibly increasing the probability of type II
error. Furthermore, interventions ranged from 6 to 12 weeks; thus,
the present findings cannot be extrapolated to long-term adapta-
tions. In the study by Izquierdo et al. (25), the total duration of the
intervention was 16 weeks, but the last 4 weeks of the intervention
were similar between RTF and RTNF (i.e., tapering time). There-
fore, we included only the results concerning the first 11 weeks.
Interestingly, differences in muscle power output in favor of the
RTNF approach arose after the tapering period. The longer in-
tervention study (i.e., 20 weeks) found in our literature search (57)
was excluded because the data were from the same research as
other included study (53). In this study, no differences in muscle
strength and muscle size between the failure and nonfailure inter-
ventions were observed after 20 weeks, regardless of the RT vol-
ume (57). The low number of included studies in the muscle
 Meta-analysis on RT to Failure or Not (2021) 00:00
hypertrophy outcome is another limitation that should be men-
tioned. Another characteristic of this study that is worthy of
mentioning is the training status of the study subjects. Except for
studies assessing athletes, most of the studies addressed untrained
subjects, and only one study assessed recreationally resistance-
trained individuals. For muscle hypertrophy, e.g., all included
studies enrolled untrained subjects. Therefore, care should be taken
when extrapolating our findings to well–resistance-trained indi-
viduals. Finally, some included studies assessed muscle power
output through vertical jump tests, and there is a substantial
problem with assessing power through vertical jump because
simply changing the jump strategy may induce changes in muscle
power (37). It is important to note that none of the aforementioned
limitations could be controlled by the authors of the current study.
This study also has its strengths. We implemented a rigorous
process to adhere to recommended practices in systematic reviews,
which included duplicate and independent procedures in all review
stages (except meta-analyses) and taking extra care to avoid du-
plicating data generated by common study samples (a unit-of-
analysis error). Besides an update in the maximal dynamic strength
outcomes, this is the first meta-analysis comparing the effects of
RTF with RTNF on muscle hypertrophy and muscle power output.
In addition, the consideration of RT volume (i.e., equalized and
nonequalized) allowed us to summarize the influence of RT volume
on the adaptations because it is not feasible to determine possible
differences between RTF and RTNF without considering the in-
fluence of RT volume. Moreover, many sensitivity analyses
allowed us to assess some potential confounders, such as training
status (i.e., athletes and nonathletes) and different muscle groups
(i.e., upper-body and lower-body muscles).
In summary, RT performed until concentric failure did not
provide additional gains in maximal dynamic strength and
maximal power output, regardless of the training volume
(i.e., equalized and nonequalized). In addition, there were sig-
nificant greater muscle strength and muscle power improvements
in the RTNF approach considering only nonequalized volume
studies. Moreover, when considering studies that equalized the
training volume, no difference between RTF and RTNF was ob-
served on muscle hypertrophy. Furthermore, sensitivity analyses
indicated that RTF and RTNF induce similar strength and power
gains in athletes and nonathletes individuals, regardless of the RT
volume. In addition, our findings suggest that different muscle
groups (i.e., upper-body and lower-body muscles) respond dif-
ferently to RTF and RTNF, and this should be taken into con-
sideration when prescribing RT.
Practical Applications
Strength and conditioning coaches should be aware that RTF
and RTNF induce comparable improvements in maximal
strength and muscle power output in athletes and nonathletes,
and even a small advantage of RTNF can be observed in
strength increase, particularly when considering lower-body
muscles. Regarding muscle hypertrophy, it seems that RTF
promotes greater muscle size gains, but these gains are related
to a greater RT volume rather than any influence of transient
induced fatigue across the sets, as can be observed in the ab-
sence of differences between RTF and RTNF when consider-
ing equalized RT volumes. Therefore, although the RTF
approach is widely used, its use should consider the risks. In
athletes who combine RT with their specific sports trainings, it
seems rational to use RTNF, considering that this approach
10
Copyright © 2021 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
will promote similar, or even greater (i.e., considering overall
analyses in nonequalized RT volumes), muscle strength and
power gains compared with RTF. Along with a possible ad-
vantage in power and strength development, RTNF may al-
low for a faster recovery after RT sessions and even prevent
overuse injuries and overtraining potential in the long term.
Considering nonathletes individuals, the approach should
consider cardiovascular and injuries risks, time to train, and
personal preference (i.e., some people may be more susceptible
to discomfort associated with muscle fatigue and can even
worsen their exercise execution). Finally, RTF and RTNF
adaptations may be different after upper-body and lower-
body exercises, and this should also be considered when pre-
scribing RT.
Acknowledgments
The authors thank the National Council for Scientific and
Technological Development (CNPq), the Coordination for the
Improvement of Higher Education Personnel (CAPES), and Research
Support Foundation of State of Rio Grande do Sul (FAPERGS). In
addition, the authors thank the authors of the included manuscripts
who answered our messages to provide additional data. Authors
disclose that no funding was received for this work from any of the
following organizations: National Institutes of Health (NIH); Well-
come Trust; Howard Hughes Medical Institute (HHMI); and
other(s). E.L. Cadore, A.F. Vieira, M. Izquierdo, and B.M. Baroni
conceived the research. A.F. Vieira and E.L. Cadore designed the
study and performed the literature search. A.F. Vieira, E.L. Cadore,
J.L. Teodoro, and S.C. Lisboa performed the selection of studies and
data extraction. A.F. Vieira, E.L. Cadore, and D. Umpierre worked
on the data analyses. E.L. Cadore, A.F. Vieira, B.M. Baroni, J.L.
Teodoro, S.C. Lisboa, D. Umpierre, and M. Izquierdo contributed in
the manuscript writing and approved the manuscript.
References
1. Cadore EL, Izquierdo M, Alberton CL, et al. Strength prior to endurance
intra-session exercise sequence optimizes neuromuscular and cardiovas-
cular gains in elderly men. Exp Gerontol 47: 164–169, 2012.
2. Cadore EL, Menger E, Teodoro JL, et al. Functional and physiological
adaptations following concurrent training using sets with and without
concentric failure in elderly men: A randomized clinical trial. Exp Ger-
ontol 110: 182–190, 2018.
3. Cadore EL, Pinto RS, Lhullier FLR, et al. Physiological effects of con-
current training in elderly men. Int J Sports Med 31: 689–697, 2010.
4. Cadore EL, Pinto RS, Reischak-Oliveira Á, Izquierdo M. Explosive type of
contractions should not be avoided during resistance training in elderly.
Exp Gerontol 102: 81–83, 2018.
5. Casas-Herrero A, Cadore EL, Zambom-Ferraresi F, et al. Functional ca-
pacity, muscle fat infiltration, power output, and cognitive impairment in
institutionalized frail oldest old. Rejuvenation Res 16: 396–403, 2013.
6. Davies T, Orr R, Halaki M, Hackett D. Effect of training leading to rep-
etition failure on muscular strength: A systematic review and meta-anal-
ysis. Sports Med 46: 487–502, 2015.
7. Davies T, Orr R, Halaki M, Hackett D. Erratum to: Effect of training
leading to repetition failure on muscular strength: A systematic review and
meta-analysis. Sports Med 46: 605–610, 2016.
8. Drinkwater EJ, Lawton TW, Lindsell RP, et al. Training leading to repe-
tition failure enhances bench press strength gains in elite junior athletes.
J Strength Cond Res 19: 382–388, 2005.
9. Drinkwater EJ, Lawton TW, McKenna MJ, et al. Increased number of
forced repetitions does not enhance strength development with resistance
training. J Strength Cond Res 21: 841–847, 2007.
10. Finn HT, Brennan SL, Gonano BM, et al. Muscle activation does not
increase after a fatigue plateau is reached during 8 sets of resistance ex-
ercise in trained individuals. J Strength Cond Res 28: 1226–1234, 2014.
 Meta-analysis on RT to Failure or Not (2021) 00:00
11. Fisher J, Smith D. Attempting to better define “intensity” for muscular per-
formance: Is it all wasted effort? Eur J Appl Physiol 112: 4183–4185, 2012.
12. Fisher JP, Blossom D, Steele J. A comparison of volume-equated knee
extensions to failure, or not to failure, upon rating of perceived exertion
and strength adaptations. Appl Physiol Nutr Metab 41: 168–174, 2016.
13. Folland JP, Irish C, Roberts J, et al. Fatigue is not a necessary stimulus for
strength gains during resistance training. Br J Sports Med 36: 370–373,
2002.
14. Fragala MS, Cadore EL, Dorgo S, et al. Resistance training for older
adults: Position statement from the National strength and conditioning
association. J Strength Cond Res 33: 2019–2052, 2019.
15. Giessing J, Fisher J, Steele J, et al. The effects of low volume resistance
training with and without advanced techniques in trained participants.
J Sports Med Phys Fitness 56: 249–258, 2014.
16. Gjøvaag TF, Mirtaheri P, Simon K, et al. Hemodynamic responses to
resistance exercise in patients with coronary artery disease. Med Sci Sports
Exerc 48: 581–588, 2016.
17. Gorostiaga EM, Navarro-Amézqueta I, Calbet JAL, et al. Energy me-
tabolism during repeated sets of leg press exercise leading to failure or not.
PLoS One 7: e40621, 2012.
18. Gorostiaga EM, Navarro-Amézqueta I, Calbet JAL, et al. Blood ammonia
and lactate as markers of muscle metabolites during leg press exercise.
J Strength Cond Res 28: 2775–2785, 2014.
19. Higgins J, Eldridge S, Li T. Chapter 23: Including variants on randomized
trials. In: Cochrane Handbook for Systematic Reviews of Interventions
Version 6.0.Cochrane. Hoboken, NJ: Wiley Online Library, 2019. pp.
2311–2316.
20. Higgins J, Green S. Chapter 8: Assessment of risk of bias in included
studies. In: Cochrane Handbook for Systematic Reviews of Interventions.
Hoboken, NJ: Wiley-Blackwell: Cochrane Book Series: Cochrane Col-
laboration, 2008. pp. 187–241.
21. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring in-
consistency in meta-analyses. BMJ 327: 557–560, 2003.
22. Hoff J, Helgerud J. Endurance and strength training for soccer players.
Sports Med 34: 165–180, 2004.
23. Izquierdo M, Häkkinen K, Gonzalez-Badillo J, Ibáñez J, Gorostiaga E.
Effects of long-term training specificity on maximal strength and power of
the upper and lower extremities in athletes from different sports. Eur J
Appl Physiol 87: 264–271, 2002.
24. Izquierdo M, Ibáñez J, Häkkinen K, Kraemer WJ, Larrion JL, Gorostiaga
EM. Once weekly combined resistance and cardiovascular training in
healthy older men. Med Sci Sports Exerc 36: 435–443, 2004.
25. Izquierdo M, Ibañez J, González-Badillo JJ, et al. Differential effects of
strength training leading to failure versus not to failure on hormonal re-
sponses, strength, and muscle power gains. J Appl Physiol 100:
1647–1656, 2006.
26. Izquierdo-Gabarren M, González de Txabarri Expósito R, Garcı́a-
Pallarés J, et al. Concurrent endurance and strength training not to failure
optimizes performance gains. Med Sci Sports Exerc 42: 1191–1199, 2010.
27. Keitaro K, Toshihiro I, Hideaki Y. Effects of 4, 8, and 12 repetition
maximum resistance training protocols on muscle volume and strength.
J Strength Cond Res 1, 2020. doi: 10.1519/JSC.0000000000003575
28. Kraemer WJ, Häkkinen K, Newton RU, et al. Effects of heavy-resistance
training on hormonal response patterns in younger vs. older men. J Appl
Physiol 87: 982–992, 1999.
29. Kraemer WJ, Patton JF, Gordon SE, et al. Compatibility of high-intensity
strength and endurance training on hormonal and skeletal muscle adap-
tations. J Appl Physiol 78: 976–989, 1995.
30. Kramer JB, Stone MH, O’Bryant HS, et al. Effects of single vs. multiple sets
of weight training: Impact of volume, intensity, and variation. J Strength
Cond Res: 143–147, 1997.
31. Krieger JW. Single versus multiple sets of resistance exercise: A meta-
regression. J Strength Cond Res 23: 1890–1901, 2009.
32. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for
reporting systematic reviews and meta-analyses of studies that evaluate
health care interventions: Explanation and elaboration. PLoS Med 6:
e1000100, 2009.
33. Loturco I, Ugrinowitsch C, Tricoli V, Pivetti B, Roschel H. Different
loading schemes in power training during the preseason promote similar
performance improvements in Brazilian elite soccer players. J Strength
Cond Res 27: 1791–1797, 2013.
34. Lovell DI, Cuneo R, Gass GC. The blood pressure response of older men
to maximum and sub-maximum strength testing. J Sci Med Sport 14:
254–258, 2011.
35. Martorelli S, Cadore EL, Izquierdo M, et al. Strength training with
repetitions to failure does not provide additional strength and muscle
11
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hypertrophy gains in young women. Eur J Transl Myol 27: 6339, 2017.
Available at: http://www.pagepressjournals.org/index.php/bam/article/
view/6339. Accessed June 27, 2017.
36. Morán-Navarro R, Pérez CE, Mora-Rodrı́guez R, et al. Time course of
recovery following resistance training leading or not to failure. Eur J Appl
Physiol 117: 2387–2399, 2017.
37. Morin J-B, Jiménez-Reyes P, Brughelli M, Samozino P. When jump height
is not a good indicator of lower limb maximal power output: Theoretical
demonstration, experimental evidence and practical solutions. Sports Med
49: 999–1006, 2019.
38. Naclerio F, Faigenbaum AD, Larumbe-Zabala E, et al. Effects of different
resistance training volumes on strength and power in team sport athletes.
J Strength Cond Res 27: 1832–1840, 2013.
39. Nery SdS, Gomides RS, Silva GVd, et al. Intra-arterial blood pressure
response in hypertensive subjects during low- and high-intensity resistance
exercise. Clinics (Sao Paulo) 65: 271–277, 2010.
40. Nóbrega SR, Ugrinowitsch C, Pintanel L, Barcelos C, Libardi CA. Effect of
resistance training to muscle failure vs. Volitional interruption at high-
and low-intensities on muscle mass and strength. J Strength Cond Res 32:
162–169, 2017.
41. Painter KB, Haff GG, Ramsey MW, et al. Strength gains: Block versus
daily undulating periodization weight training among track and field
athletes. Int J Sports Physiol Perform 7: 161–169, 2012.
42. Pareja-Blanco F, Rodrı́guez-Rosell D, Sánchez-Medina L, Gorostiaga E,
González-Badillo J. Effect of movement velocity during resistance training
on neuromuscular performance. Int J Sports Med 35: 916–924, 2014.
43. Pareja-Blanco F, Rodrı́guez-Rosell D, Sánchez-Medina L, et al. Effects of
velocity loss during resistance training on athletic performance, strength
gains and muscle adaptations. Scand J Med Sci Sports 27: 724–735, 2017.
44. Pinto S, Cadore E, Alberton C, et al. Effects of intra-session exercise sequence
during water-based concurrent training. Int J Sports Med 35: 41–48, 2014.
45. Radaelli R, Botton CE, Wilhelm EN, et al. Time course of low- and high-
volume strength training on neuromuscular adaptations and muscle
quality in older women. Age (Dordr) 36: 881–892, 2014.
46. Reid KF, Fielding RA. Skeletal muscle power: A critical determinant of
physical functioning in older adults. Exerc Sport Sci Rev 40: 4–12, 2012.
47. Rooney KJ, Herbert RD, Balnave RJ. Fatigue contributes to the strength
training stimulus. Med Sci Sports Exerc 26: 1160–1164, 1994.
48. Sampson JA, Groeller H. Is repetition failure critical for the development
of muscle hypertrophy and strength?: Failure is not necessary for strength
gain. Scand J Med Sci Sports 26: 375–383, 2015.
49. Sanborn K, Boros R, Hruby J, et al. Short-term performance effects of
weight training with multiple sets not to failure vs. a single set to failure in
women. J Strength Cond Res 14: 328–331, 2000.
50. Sánchez-Medina L, González-Badillo JJ. Velocity loss as an indicator of
neuromuscular fatigue during resistance training. Med Sci Sports Exerc
43: 1725–1734, 2011.
51. Schoenfeld BJ, Peterson MD, Ogborn D, Contreras B, Sonmez GT. Effects
of low- vs. High-load resistance training on muscle strength and hyper-
trophy in well-trained men. J Strength Cond Res 29: 2954–2963, 2015.
52. Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for
systematic review and meta-analysis protocols (PRISMA-P) 2015: Elab-
oration and explanation. BMJ 349: g7647, 2015.
53. da Silva LXN, Teodoro JL, Menger E, et al. Repetitions to failure versus
not to failure during concurrent training in healthy elderly men: A ran-
domized clinical trial. Exp Gerontol 108: 18–27, 2018.
54. Steele J. Intensity; in-ten-si-ty; noun. 1. Often used ambiguously within
resistance training. 2. Is it time to drop the term altogether? Br J Sports
Med 48: 1586–1588, 2013.
55. Sundstrup E, Jakobsen MD, Andersen CH, et al. Muscle activation
strategies during strength training with heavy loading vs. Repetitions to
failure. J Strength Cond Res 26: 1897–1903, 2012.
56. Tajra V, Vieira DCL, Tibana RA, et al. Different acute cardiovascular
stress in response to resistance exercise leading to failure versus not to
failure in elderly women with and without hypertension—A pilot study.
Clin Physiol Funct Imaging 35: 127–133, 2015.
57. Teodoro JL, da Silva LXN, Fritsch CG, et al. Concurrent training per-
formed with and without repetitions to failure in older men: A randomized
clinical trial. Scand J Med Sci Sports 29: 1141–1152, 2019.
58. Viechtbauer W, Cheung MWL. Outlier and influence diagnostics for
meta-analysis. Res Synth Methods 1: 112–125, 2010.
59. Willardson JM. The application of training to failure in periodized
multiple-set resistance exercise programs. J Strength Cond Res 21:
628–631, 2007.
60. Willardson JM, Norton L, Wilson G. Training to failure and beyond in
mainstream resistance exercise programs. Strength Cond J 32: 21–29, 2010.